=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700197894
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREGORY L. SAWYER DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2010
-----------------------------------------------------
Last Update Date | 06/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15951 LOS GATOS BLVD STE 8
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-3428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-402-0900
-----------------------------------------------------
Fax | 408-402-0922
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15951 LOS GATOS BLVD STE 8
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-3428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-402-0900
-----------------------------------------------------
Fax | 408-402-0922
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. GREGORY L SAWYER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 408-402-0900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 45678
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 41431
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 26524
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------